原发免疫性血小板减少症树突状细胞异常免疫反应机制

目的 探讨影响原发免疫性血小板减少症(ITP)患者树突状细胞功能异常的基因,为ITP治疗寻求新方法。 方法 随机选取ITP患者(ITP组)8例和同期入院体检健康者8例正常对照组为研究对象,分离外周单个核细胞并在体外诱导分化为单核细胞源性树突状细胞(moDCs),选取ITP组和正常对照组moDCs样本各3例,使用Illumina Hiseq平台进行转录组测序,并完成生物信息学分析。其他moDCs样本分为对照组、ITP组和ITP+雷帕霉素处理组,采用Western blotting法检测哺乳动物雷帕霉素靶蛋白复合体1(mTORC1)信号通路激活情况,采用流式细胞术检测moDCs表面分子表达,采用酶联免疫吸附(ELISA)法检测moDCs细胞因子分泌能力。 结果 差异性表达分析显示,与正常对照组相比,ITP组患者moDCs中有161个基因表达上调,320个基因表达下调,差异有统计学意义(P<0.05)。利用基因本体论(GO)和京都基因与基因组百科全书(KEGG)数据库对差异基因进行功能和分子通路注释,结果表明差异基因主要集中在T细胞分化、T细胞共刺激、T细胞活化等生物学过程和T细胞受体信号通路等信号途径。基因集富集分析(GSEA)显示,ITP组患者树突状细胞中mTORC1信号通路基因表达上调。进一步验证发现,ITP组患者moDCs中磷酸化哺乳动物雷帕霉素靶蛋白(mTOR)和mTORC1活化标志物磷酸化核糖体蛋白S6激酶(S6K)相对含量升高,同时ITP组患者moDCs共刺激分子CD80、CD86和促炎因子白介素6(IL-6)、白介素12(IL-12)的表达增加,而白介素10(IL-10)、转化生长因子-β(TGF-β)表达降低。使用mTORC1抑制剂雷帕霉素可以抑制moDCs共刺激分子CD80、CD86的表达和促炎因子IL-6、IL-12的分泌,并上调IL-10的表达,而对TGF-β的分泌无明显影响。 结论 ITP患者moDCs中mTORC1信号通路高度激活,使用mTORC1抑制剂雷帕霉素可以改善moDCs的免疫调节能力。因此,mTORC1信号通路可能是调节ITP患者moDCs功能异常的新靶点。     

IL-6通过调控JAK2/STAT3信号通路减轻急性肺损伤的机制研究

目的探讨IL-6通过调控酪氨酸蛋白激酶2（JAK2）/信号传导与转录激活因子3（STAT3）信号通路减轻急性肺损伤（ALI）的机制。方法将人肺癌细胞A549细胞分为空白对照组、脂多糖（LPS）组、LPS+IL-6过表达组、LPS+IL-6干扰组、LPS+空载组。空白对照组细胞正常培养,LPS组LPS处理细胞,LPS+IL-6过表达组LPS处理细胞后转染IL-6过表达质粒,LPS+IL-6干扰组LPS处理细胞后转染IL-6干扰质粒,LPS+空载组LPS处理细胞后转染空载质粒。采用细胞计数试剂盒法检测细胞增殖率,流式细胞术检测细胞凋亡率和活性氧（ROS）水平,试剂盒检测丙二醛（MDA）和超氧化物歧化酶（SOD）水平,ELISA法检测炎性因子TNF-α、IL-6、IL-1β水平,qRT-PCR法检测IL-6、JAK2、STAT3mRNA表达水平,Westernblot法检测磷酸化JAK2（p-JAK2）/JAK2、磷酸化STAT3（p-STAT3）/STAT3蛋白表达水平。结果与空白对照组比较,过表达IL-6可增加LPS诱导的ALI细胞凋亡率、ROS、MDA、TNF-α、IL-6、IL-1β水平,JAK2、STAT3mRNA表达水平,p-JAK2、p-STAT3蛋白表达水平,降低细胞增殖率和SOD水平;干扰IL-6则相反。结论IL-6可通过抑制JAK2/STAT3信号通路的激活,降低氧化应激和炎症反应,从而减轻ALI。     

白介素4对脂多糖刺激后小胶质细胞表型改变及其机制

目的 研究IL-4对LPS刺激后小胶质细胞表型改变作用及其机制。方法 以原代小胶质细胞研究对象,在脂多糖(LPS)和白介素4(IL-4)的刺激下,通过免疫荧光、蛋白印记技术、实时定量PCR检测细胞的表型改变、炎性因子表达和信号通路活化情况。结果 在LPS作用后,小胶质细胞形态由静息状态下的长分支状变为具有短分支的阿米巴样,M1型小胶质细胞标记iNOS以及TLR4/MyD88/NF-κB信号通路相关蛋白表达上调,细胞向M1型转化。加入IL-4后,iNOS以及NF-κB的磷酸化水平下降,M2型标记蛋白Arg1以及STAT6磷酸化表达显著上调,细胞从M1 型向M2转化。抑制IL-4及其下游信号通路 STAT6后,IL-4对小胶质细胞TLR4及其下游信号通路的抑制作用及M2表型转化功能均被抑制。结论 IL-4可以通过上调STAT6磷酸化水平抑制LPS介导的TLR4/MyD88/NF-κB信号通路活化,从而抑制下游的炎性因子表达,促进细胞表型由M1向M2型转变。     

可溶型DC-SIGN对LPS诱导THP-1细胞炎性应答的调控作用

目的探讨可溶型树突状细胞特异性的结合细胞间粘附分子的非整合素(sDC-SIGN)对脂多糖(LPS)刺激的单核细胞炎症反应的调节作用。方法以人急性单核细胞白血病细胞株(THP-1)为研究对象,分为空白组、200 ng/ml sDC-SIGN单独处理组、LPS单独刺激组、LPS刺激同时加100 ng/ml sDC-SIGN处理组和LPS刺激同时加200 ng/ml sDC-SIGN处理组,刺激后不同时间点收集上清和细胞。ELISA检测细胞上清中细胞因子含量、Q-PCR检测细胞内细胞因子的mRNA表达并利用Western blot方法检测细胞内细胞外调节蛋白激酶(ERK)和核转录因子-κB(NF-κB)信号通路的活化状况。结果不同浓度的sDC-SIGN均可抑制LPS刺激炎性细胞因子TNF-α、IL-6和IFN-α的mRNA表达和蛋白分泌,同时促进抑炎细胞因子IL-10的mRNA表达和蛋白分泌,且sDC-SIGN的抑制效果与浓度呈依赖关系;研究结果亦显示,sDC-SIGN减弱LPS刺激THP-1细胞诱导ERK和NF-κBP65的磷酸化水平。结论sDC-SIGN蛋白对LPS诱导的单核细胞炎症应答具有负向调控作用。     

激酶抑制剂WP1066对前列腺基质细胞J

目的 研究JAK2信号通路在前列腺基质细胞中的作用及激酶抑制剂WP1066对其表达的影响。方法 采用Western blot检测单纯良性前列腺增生（BPH）者（n=4）和合并重度组织炎症BPH患者（n=4）前列腺组织中的JAK2和STAT3的磷酸化程度来验证其所介导的信号通路的活化情况,并检测其抑制剂WP1066在前列腺基质细胞上抑制JAK2和STAT3由白介素-6（IL-6）带来的活化作用。结果 在BPH合并重度组织炎症的前列腺组织中,JAK2的磷酸化水平（pJAK2）升高,使用WP1066处理细胞并不会降低JAK2或STAT3的表达。但在抑制剂WP1066所处理的细胞上,无论是JAK2还是STAT3都无法检测到磷酸化,表明JAK2-STAT3的信号通路被抑制。使用IL-6可增加pJAK2和pSTAT3的表达,此结果可被WP1066阻断。结论 JAK/STAT信号通路在BPH合并重度组织学炎症前列腺组织中呈现活化状态,激酶抑制剂WP1066可抑制STAT3的活化。     

脂多糖对人肝内胆管上皮细胞IL-6/STAT3信号通路的影响

目的 探讨脂多糖(LPS)对正常人肝内胆管上皮细胞(HiBECs)白介素(IL)-6/STAT3信号通路的影响.方法 HiBECs细胞常规体外培养,使用不同浓度的LPS(0、0.1、1、2、4、8 μg/ml),分别作用该细胞24、48、72 h后,ELISA法检测IL-6的表达水平,确定LPS的最适刺激浓度及最佳刺激时间,再以其进行后续实验;RT-qPCR法测定c-Myc mRNA、Mcl-1 mRNA的表达情况;Western blot法测定p-STAT3/STAT3蛋白比例及c-Myc、Mcl-1蛋白的表达情况.结果 LPS能够促进HiBECs细胞IL-6分泌,并且在4 μg/ml、24 h时IL-6的分泌量达最大(F=16.492、17.763,P<0.001、P<0.01);LPS刺激HiBECs细胞后,c-Myc mRNA、Mcl-1 mRNA表达上调 (P<0.01);p-STAT3/STAT3蛋白比例增高(P<0.05),c-Myc(P<0.001)、Mcl-1(P<0.05)蛋白表达增多.结论 LPS能够激活HiBECs细胞IL-6/STAT3信号通路,并且可能通过该信号通路促进Mcl-1、c-Myc的表达.     

JAK2/STAT3途径在IL-6抑制LPS诱导的树突状细胞分化成熟中的作用

目的 观察JAK2/STAT3信号途径在IL-6抑制LPS诱导的小鼠髓源性树突状细胞(bone marrow-derived dendritic cells,BMDCs)分化成熟中的作用.方法 分离小鼠骨髓细胞,采用黏附法结合GM-CSF和IL-4刺激法在体外培养BMDCs;用相差倒置显微镜观察BMDCs的形态特点;用LPS诱导DCs成熟;采用流式细胞术观察IL-6处理与否,LPS诱导的BMDCs在表型上的变化;Western blot检测BMDCs细胞质p-JAK2、总STAT3和P-STAT3的表达水平.结果 形态观察和FCM分析的结果表明:体外成功培养了纯度较高的高表达CD11c的BMDCs,LPS能明显诱导BMDCs表面MHC-Ⅱ类分子和共刺激分子CD80、CD86、CD40的表达上调;而经过IL-6处理后,LPS诱导BMDCs表面MHC-Ⅱ类分子、CD80、CD86、CD40表达上调的能力被显著削弱(P＜0.01).Western blot结果显示,与单独用LPS处理的BMDCs相比,经IL-6处理后的BMDC中p-JAK2、P-STAT3表达随作用时间增加而明显上调,提示IL-6促进JAK2/STAT3信号途径活化.结论 JAK2/STAT3信号途径参与了IL-6抑制LPS诱导的BMDCs成熟过程.     

SOCS3经JAK/STAT信号通路调控气道黏蛋白高分泌

目的 研究细胞因子信号转导抑制因子3(SOCS3)在炎症情况下经JAK/STAT通路调控气道黏液高分泌.方法 培养人气道16HBE上皮细胞,设置空白对照组、白介素(IL)-6处理组、IL-6和microRNA (miR)-203处理组,Westernblot法分析细胞中磷酸化JAK激酶(p-JAK1/2)、SOCS3、黏蛋白(MUC) 5AC蛋白水平;Real-time法检测各组细胞中SOCS3、STAT3、MUC5AC mRNA表达量;ELISA法检测各组培养上清液中p-JAK1/2、SOCS3、MUC5AC蛋白含量.结果 在IL-6刺激下,IL-6处理组的p-JAK1/2、SOCS3、MUC5AC蛋白量及SOCS3、STAT3 mRNA含量较空白对照组显著升高(P＜0.05),IL-6和miR-203处理组的p-JAK1/2、MUC5AC蛋白量及STAT3 mRNA含量较IL-6处理组显著升高(P＜0.05),但SOCS3 mRNA与IL-6处理组比较差异无统计学意义,SOCS3蛋白含量较IL-6处理组显著降低(P＜0.05).结论 细胞在IL-6刺激后SOCS3呈现高表达,同时经JAK/STAT信号通路负反馈调控MUC5AC.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.